Provider Demographics
NPI:1952466047
Name:SMITH, CHERYL A (MD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:A
Last Name:SMITH
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Gender:F
Credentials:MD
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Mailing Address - Street 1:10 MOUNT MORRIS PARK WEST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-6308
Mailing Address - Country:US
Mailing Address - Phone:212-289-8416
Mailing Address - Fax:801-289-8417
Practice Address - Street 1:10 MOUNT MORRIS PARK WEST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-6308
Practice Address - Country:US
Practice Address - Phone:800-775-8979
Practice Address - Fax:801-289-8417
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2011-12-02
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Provider Licenses
StateLicense IDTaxonomies
NY195275207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01907208Medicaid
NY01907208Medicaid